Cavities and spaces of the skull, paranasal sinuses, opening in the skull bases

(1)

Cavities and spaces of the skull, paranasal sinuses, opening in the

skull bases

MUDr.Veronika Němcová, CSc.

(2)

Basis cranii interna

^F

Amin Amaj

T

O E

Internal surfice of the cranial base

(3)

Anterior cranial fossa

Crista galli

Foramen caecum

Cribriform plate Prechiasmatic groove

Optic canal Lesser wing

Anterior clinoid process Impressiones gyrorum et juga

cerebralia

(4)

Anterior cranial fossa - repetition

(5)

Middle cranial fossa openings

Foramen rotundum Foramen venosum Foramen ovale

Foramen spinosum Superior orbital fissure

Foramen lacerum

Hiatus for the lesser petrosal nerve

Hiatus for the greater petrosal nerve

(6)

Middle cranial fossa structures

Hypophysial fossa

Carotid sulcus

Dorsum sellae Trigeminal impression

Grooves for the lesser and

graeter petrosal nerves

Arcuate eminence

Groove of the superior petrosal sinus

Tegmen tympani

(7)

Middle cranial fossa - repetition

(8)

Posterior cranial fossa - openings

Foramen magnum hypoglossal canal

Jugular foramen

Internal acustic meatus

Apertura externa

aquaeductus vestibuli

Condylar canal

(9)

Posterior cranial fossa structures

Clivus

Cerebellar fossa

Internal occipital crest

Internal occipital protuberance Sulcus sinus transversi

Opening for the emissary vein from mastoid

foramen Groove of the

sigmoid sinus

Subarcuate fossa Groove of the inferior petrosal sinus

Groove of the superior petrosal sinus

Cerebral fossa

(10)

n.VII n.VIII

n.Xn.IX n.XI

n.XII Sites for passage for nerves in

the posterior cranial fossa

(11)

Fossa cranii posterior -repetition

(12)

Openings in the internal surface of cranial base

1-lamina cribrosa 2-canalis opticus

3-fissura orbitalis superior 4-foramen rotundum

5-foramen ovale

6-foramen spinosum 7-foramen lacerum

8-hiatus nervi petrosi minoris 9-hiatus nervi petrosi majoris 10-porus acusticus internus 11-foramen jugulare

12-canalis nervi hypoglossi 13-foramen magnum

14-canalis condylaris 15-foramen mastoideum

1 2 3

4 5 6

7

8 9 10

11 12

13

14 15

(13)

I. Olfactory nerves II. Optic nerve

III. Oculomotory nerve IV. Trochlear nerve

V. Trigeminal 1.Ophthalmic 2.Maxillary 3.Mandibular VI. Abducent nerve

VII. Facial nerve

VIII. Vestibulocochlear nerve IX. Glossopharyngeal nerve X. Vagus

XI. Accessory nerve XII. Hypoglossal nerve

Cranial nerves

(14)

Basis cranii interna

Anterior cranial fossa Frontal lobes, n.I. a n.II., falx cerebri

orbitocranial canal

Middle cranial fossa temporal lobes,

hypophysis cerebri,

eye-muscle nerves and V/1, branches of n.V, cavernous sinus, middle meningeal art., sphenopetrosal synchondrosis

Posterior cranial fossa, brainstem, cerebellum, occipital lobes, grooves of sinuses, emissary veins, n.VII a n.VIII, endolymphatic duct, nn.IX,X,and XI, spinal cord and n.XI and vertebral art., n.XII Posterior border of lesser wings and prechiasmatic sulcus

I

Ophthalmic art. III, IV, VI, V/1

Sup. ophthalmic vein

V/2

V/3 Middle meningeal art.

Crista pyramidis, dorsum sellae

II

Greater (from N.VII) and lesser(fromN.IX) petrosal nerves

Ant. meningeal art.

VII, VIII

IX,X,XI Vertebral art.

XII

Post. meningeal art.

Int.carotid art.

(15)

Sulcus sinus sigmoidei Sulcus sinus petrosi

superioris

Sulcus sinus transversi

Grooves of sinuses

Sulcus sinus petrosi inferioris

(16)

n.II

Sup.opthalmic vein Int. carotid art.

n.III n.V n.IV.

n.VI

n.VII and n.VIII Falx cerebri

n.IX.,X., IX n.XII

Vertebral art.

r. spinalis n.XI.

Middle

meningeal art.

Sigmoid sinus

Transverse sinus Sup. sagittal sinus

confluens of sinuses infundibulum

hypophysae

(17)

Repetition

Tentorium of the

cerebellum Vertebral art.

Middle

meningeal art.

Int. carotid art.

Cavernous sinus

(18)

Nasal cavity and paranasal sinuses

Sphenoid sinus Posterior ethmoidal cells

Frontal sinus

Anterior ethmoidal cells

Nasolacrimal duct

Maxillary sinus

(19)

Paranasal sinuses - development

(20)

Piriform aperture Frontal sinus

Anteriorly

Middle nasal meatus

Superior nasal meatus

Inferior nasal meatus

(21)

Choana

Posteriorly

(22)

Nasal septum:

perpendicular plate of ethmoid

vomer

Cavum nasi osseum

Roof:

nasal bone frontal bone

Cribriform plate of ethmoid

sphenoid (body)

Floor:

palatine process of maxilla

horizontal plate of palatine bone

(23)

Lateral wall of the nasal cavity

Frontal process and body of maxilla

Lacrimal bone Ethmoid

Inferior nasal concha

Perpendicular plate of palatine bone

Medial lamina of pterygoid process

(24)

Bony nasal cavity - repetition

sphenopalatine foramen

(25)

Palatum durum

Os incisivum

Processus palatinus maxillae

Lamina horizontalis ossis palatini

Foramen incisivum

(nervus nasopalatinus)

(26)

F

Z

M

Vomer

Frontal section through the maxillary sinus (schema)

Ant. cranial fossa

Frontal sinus

Orbit

Maxillary sinus

Semilunar hiatus Ant.ethmoid cells

Post.ethmoid cells

(27)

Frontální řez přes sinus maxillaris

3 2

8 4 5

6

1

Frontal section through the

maxillary sinus

(28)

X-ray picture of the skull AP projection

4 2

3

8

(29)

Sinusitis

(30)

X-ray picture of

paranasal sinuses (Waters projection)

Frontal sinus

Maxillary sinus Sphenoid sinus

(31)

RTG Waters projection - sinusitis

(32)

Pansinusitis after tsunami

Normal CT of paranasal sinuses on the same levels

(33)

Fossa

hypophysialis Sinus sphenoidalis

Sinus maxillaris X-ray

picture of the skull lateral

projection

Sinus frontalis

(34)

Infratemporal fossa

Content:

Pterygoid muscles Pterygoid plexus Maxillary artery

Branches of the mandibular nerve Otic ganglion

Buccal adipose body Borders:

Sup.: infratemporal crest Ant.: maxillary tuberosity Lat.: ramus of the mandible

Med.: lateral plate of the pterygoid process

(35)

Infratemporal fossa openings

Mandibular nerve (oval foramen)

Middle meningeal art (spinous foramen)

Inf.ophthalmic vein (inf. orbital fissure)

Inf. alveolar nerve (mandibular canal)

Mylohyoid nerve (mylohyoid groove)

(36)

Infratemporal fossa

repetition

(37)

Pterygoid muscles Otic ganglion

Maxillary artery Branches of mandibular nerve

M L

(38)

N.lingualis

N.alveolaris inf.

Corpus adiposum N.mandibularis

Arcus zygomaticus Vomer

Sinus sphenoidalis

in oval foramen

Processus pterygoideus

Frontal section through the

temporal and infratemporal region

(39)

Frontal section through the

temporal and infratemporal region

repetition

(40)

Plexus pterygoideus

V.jugularis externa V.jugularis interna

V.temporalis spf.

Vv.diploicae V.angularis

V.facialis

V.retromandibularis Pterygoid plexus in the infratemporal fossa

(41)

Maxillary artery in the infratemporal fossa

(42)

N.auriculotemporalis N.VII

(stylomastoid foramen)

N.alveolaris inf.

R.mylohyoideus N.lingualis

N.buccalis

Nerves in the infratemporal fossa – branches of mandibular nerve (V/3)

(43)

Pterygopalatine fossa – deepest part of the infratemporal fossa

(44)

Pterygopalatine fossa

(45)

Pterygopalatine fossa

Orbit

Nasal cavity

Oral cavity Middle cranial fossa

External surface of cranial base Borders:

Ant. - maxilla

Post. – pterygoid process Med.- perpendicular plate

of palatine bone Lat.-pterygomaxillary

fissure

Sup.- greater wing of sphenoid

Inf. – foramen palatinum majus

(46)

Maxilla

Pterygoid process Inferior orbital fissure Sphenopalatine foramen

Pterygoid canal Foramen rotundum

Greater palatine canal

Pterygopalatine fossa lateral aspect -schema

(47)

Maxilla

PtPr IOFI SPF

PC FR

V/2 somatosensory

Greater petrosal nerve (VII) parasympathetic

Lesser petrosal nerve (plexus a.carotis int.) sympathetic

GPC

Pterygopalatine fossa schema - nerves

Pterygopalatine ganglion

(48)

Pterygopalatine fossa lateral aspect - nerves

Maxilla

PtPr IOF SPF

PC FR

V/2 Infraorbital nerve

Zygomatic nerve

nn.pterygopalatini

Palatine nerves (greater and lesser) Nasal branches

Greater petrosal nerve (VII) parasympathetic

Lesser petrosal nerve (plexus a.carotis int.) sympathetic

somatosensory

Pterygopalatine ganglion

communicating branch to zygomatic nerve (for lacrimal gland)

(49)

Fossa pterygopalatina schema– branches of maxillary artery

M

Post. sup. alveolar art.

Ant. sup. alveolar art.

Sphenopalatine art- Rr. nasales post.lat.+septi

Descending palatine art.

Greater and lesser palatine art.

Infraorbital art.

A.canalis pterygoidei

(50)

Fossa pterygopalatina schema – nerves and arteries

M

Ant. sup. alveolar nerves and art.

Sphenopalatine art.

Nasal branches

A.palatina descendens Infraorbital nerve and art.

A.canalis pterygoidei

Zygomatic nerve Maxillary nerve

Greater petrosal nerve Lesser petrosal nerve

Pterygopalatine ganglion

Post. sup. alveolar nerves and art.

Greater and lesser palatine nerves and art.

(51)

Pterygopalatine fossa medial aspekt

lamina perpendicularis ossis palatini removed

Pterygoid canal

Greater palatine canal

Incisive canal

(52)

M L E

F

LW

Z

Orbital cavity

P GW

(53)

Optic canal

Infraorbital foramen Inferior orbital fissure

Superior orbital fissure

Zygomaticofacial foramen

Supraorbital foramen Frontal notch

Ant.and post.

ethmoid foramen Trochlear fovea Fossa for lacrimal gland

Fossa for lacrimal sac

Orbital cavity – openings and fossas

(54)

Orbital cavity – sites for passage

Anterior cranial fossa Middle cranial fossa

Infratemporal and

pterygopalatine fossa

Orbitocranial canal Orbitoethmoid canal

Nasolacrimal canal

(55)

lacrimal

frontal

n.IV

Infraorbital nerve and art.

Zygomatic nerve Inf. ophthalmic vein

Anulus tendineus communis

nasociliary n.III

n.VI

ant. et post.

ethmoidal nerves and art.

Supraorbital

Supratrochlear n.II

Ophthalmic art.

Orbital cavity arteries and nerves

Superior ophthalmic vein

(56)

Orbital cavity repetition

(57)

lacrimal nerve from V/1

frontal nerve from V/1 nasociliary nerve -

from V/1

and ophthalmic art.

trochleary nerve(IV)

n. abducens (VI)

optic nerve(II) oculomotory (III) Nerves in the superior part of the orbite

(58)

Nasopalatine nerve

Greater palatine nerve and art.

Mandibular nerve Middle meningeal art.

Greater and lesser petrosal nerve

Internal carotid art.

Facial nerve n.IX.,X., IX

Int. Jugular vein n.XII

emissarium mastoideum emissarium condylare

r.spinalis n.XI Vertebral art

Basis cranii externa -sites for passage for vessels and nerves

(59)

Basis cranii externa

repetition

¹ ₂

3 4

5

6

7 9 8

10 11

12 13

14 15 16

1-incisive canal

2-greater palatine foramen 3-inf.orbital fissure

4-foramen ovale 5-foramen spinosum 6-mastoid process 7-stylomastoid foramen 8-carotid canal

9-jugular foramen 10-foramen magnum 11-condylar canal 12-occipital condyle 13-mastoid notch 14-foramen lacerum 15-vomer

Cavities and spaces of the skull, paranasal sinuses, opening in the skull bases